May 10, 2018

Dr. Jones: How do healthcare providers know what is the right recommendation just for you? What do we think we know about your biology and your behavior to help you make the right decision? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is "The Seven Domains of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: There's a phrase I've often heard from my women patients as they explain why they've decided to cut their pill in half or not take what I've prescribed. It's a phrase I've never heard come out of a guy's mouth. It is, "I know my body." Have you ever heard a guy say that? To me, that means that the person knows that their biology and their emotional makeup is unique to them and they're sensitive to this uniqueness. So the "I know my body" phrase, if men don't say that, is it because their guy genes make it impossible for them to know their body? Or is it because it isn't a common guy behavior to say a thing like that? And how do we translate those differences in how we take care of people?

Today, in The Scope studio, we are joined by Dr. Leslie Halpern, who is head of oral and maxillofacial surgery at the University of Utah School of Dentistry. Dr. Halpern is trained as a doctor and a dentist and a neuroscientist, but more importantly, she is the co-director of the Women in Health, Medicine, and Science at the University of Utah. Welcome, Dr. Halpern.

Dr. Halpern: A pleasure and a privilege to be here.

Dr. Jones: Thank you. So, recently, scientists and social scientists and educators came to Salt Lake City from around the country to a summit on sex and gender in healthcare. What was that about?

Dr. Halpern: Okay. Well, as a healthcare provider, we know that when you look at a man and you look at a woman, they are not equal. There are many . . .

Dr. Jones: Equal but not the same, maybe?

Dr. Halpern: Well, equal but not the same, yes.

Dr. Jones: We're just saying that at around the table here.

Dr. Halpern: Yes. Well, I'm a mother of sons. So I guess so.

Dr. Jones: Me too.

Dr. Halpern: Large gaps exist about how men and women experience medical conditions. So, in order to understand the roadmap, you have to understand the definitions of sex and gender because many people, including myself, we're confused. Sex is the biological construct segregating male and female based upon reproductive organs and chromosome complement. Gender refers to a person's self-representation and behavior as man or woman within the context of social structure and culture.

Taking it one step further, what is the definition of sex and gender-based medicine, which is really what this is all about? And that is the practice of medicine based upon the understanding that biology and social factors have an important implication for screening, diagnosis, treatment, and prevention. And our medical and health community as a whole must be aware of how a person's sex and gender can affect their body's responsiveness to disease identification.

Dr. Jones: Can you give us a few examples?

Dr. Halpern: Absolutely. The number one example is cardiovascular disease. In women, it's more of a silent disease than in men. So when women come in to an emergency room, for instance, with symptoms such as shortness of breath, fatigue, and maybe some chest pain, they will not initially be brought into the cath lab as a man may who comes in with chest pain.

Dr. Jones: Right. So they won't get the invasive, the serious look at their coronary arteries because those are kind of vague symptoms.

Dr. Halpern: Absolutely.

Dr. Jones: I kind of feel that way sometimes just, you know, walking around my garden.

Dr. Jones: Sure. And when many women do come into the emergency room, many times it is thought that they may be exposed to stressors in their life, and so they're manifesting the response to stressors. And this may be a very golden window where they do indeed need to be evaluated and diagnosed.

Dr. Jones: Well, women also, when you ask them why they might be experiencing any one of a number of chronic pain or headache or chest pain, they will tell me, even without me asking, "Doctor, do you think it's stress?" So women themselves say, "Oh no, a heart attack is that terrible, crushing chest pain, so what I'm having must be stress."

So we're internally more willing to accept stress is the cause of our symptoms, so we could be part of the problem maybe even.

Dr. Halpern: We are indeed part of the problem. And as my colleague, Dr. Jenkins has stated that the problem is that even as healthcare providers, we are sexing diseases. And what I mean by sexing diseases, meaning that our symptoms can mask the identification of the same disease that presents itself differently between a woman and a man.

Dr. Jones: Well, so we want our clinicians to know about our bodies and know these differences. So how do we teach this kind of healthcare?

Dr. Halpern: As was shown by surveys that was sent around to medical students around the country before the 2018, that we have to teach a strategy based upon a curricula that is transparent. As an addendum, it wasn't only medical input at the 2018 summit, dentistry, nursing, pharmacology, and allied health field participants were also included, building a very strong inter-professional collaborative.

Dr. Jones: So what's amazing here at the University of Utah is that our medical school is on the campus with our dental school, our pharmacy school, our nursing school, and our Department of Anthropology and Health Sciences. We have this big, global view of the person that we could really share here.

Dr. Halpern: Yes. And I truly believe that the University of Utah will provide a flagship model of inter-professional collaborative practice that may be a model for other schools across the country nationally and internationally.

Dr. Jones: Well, thank you very much. And I think that we're going to be hearing more about this as we go on. We want our clinicians to see us as individuals informed by our gender, our sex, our color, our culture, our tribe, and our faith. As educators, we're working on this. And thanks for joining us on The Scope.

Dr. Halpern: Thank you for the privilege.

Dr. Jones: Yeah.

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